Healthcare Provider Details

I. General information

NPI: 1942483839
Provider Name (Legal Business Name): STATE OF HAWAII DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 LANAI AVE SUITE 6
LANAI CITY HI
96763
US

IV. Provider business mailing address

1250 PUNCHBOWL ST RM 256
HONOLULU HI
96813-2416
US

V. Phone/Fax

Practice location:
  • Phone: 808-984-2150
  • Fax: 808-984-2155
Mailing address:
  • Phone: 808-590-7320
  • Fax: 808-586-4745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RAQUEL B. NAKAHARA
Title or Position: FINANCIAL RESOURCE SPECIALIST
Credential:
Phone: 808-590-7320